Atherosclerosis: a problem in newer public health
Keys, A.
Journal of the Mount Sinai Hospital new York 20(2): 118-139
1953
ISSN/ISBN: 0099-9695 PMID: 13085148 Document Number: 3118
The material discussed above covers too large a field to be summarized except in terms of the conclusions which emerge from it. These are: 1) Compared with other countries where records are comparable, the total age-specific death rate over most of the span of adult life is excessively high in the United States and this American inferiority is more marked with men than with women. 2) The excessive death rate of adults in the United States is attributable to an excessive mortality from "degenerative" heart disease-coronary disease, angina pectoris, myocardial infarction, chronic myocarditis and myocardial degeneration. These conditions cannot be clearly separated in vital statistics and probably share some common features in basic etiology. 3) The concentration of total cholesterol in the blood serum bears an important relationship to the development of atherosclerosis and its sequelae and related clinical conditions. Similar relationships exist with the concentrations of certain "giant molecules" (Sr 10-20, Sr 12-20) and of certain lipoprotein fractions separable by precipitation methods. 4) Measurements of total cholesterol and of Sr 12-20 particles in the serum afford highly significant differentiation between groups of men who are clinically healthy and groups of men who have or are likely to develop coronary heart disease. There is no important difference between the cholesterol and the Sr 12-20 measurements in this regard, particularly with men before old age. 5) These measurements of total cholesterol or of Sr 12-20 concentrations in the serum have very little practical value for individual diagnosis or prognosis, the index of forecasting efficiency being of the order of 20 per cent. 6) The total cholesterol concentration in the serum of man is substantially independent of the dietary cholesterol intake over the whole range of possible human diets. 7) The total cholesterol concentration in the serum of men habitually on diets characteristic of the United States changes directly with changeS in the total fat content of the diet. The response to the new diet begins in a few clays and reaches a new plateau in a few weeks, this new plateau being relatively stable for at least several months. There is no indication of a difference in animal versus vegetable fat in evoking the serum response. 8) Comparison of men from populations always living on different amounts of total fat intake indicates that in youth and to the early thirties the serum cholesterol concentration is relatively independent of the diet if there is calorie sufficiency. But from the thirties through the fifties the serum concentration is increasingly dependent on the amount of total fat in the diet. 9) The different age-specific death rates of men 40 to (i5 years old from degenerative heart disease in different countries are directly related to the differences in those countries in the proportion of the total calories derived from total fats. The relationship in the case of women is much less clear. 10) For the 40 years of records available, the proportion of fat calories in the total American food consumption has steadily increased. (hi the basis of comparisons with other countries at present this rise in fat consumption might be predicted to be associated with an increase of the order of 50 to 100 per cent in mortality from degenerative heart disease for men aged 40 to 65. U. S. vital statistics are, in fact, compatible with this prediction. 11) The facts and relationships indicated here are of such importance as to warrant a large extension of this type of epidemiological research. It is difficult to escape the conclusion that public health programs must take cognizance of the information already at hand.
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